AB1344 DO PATIENTS ON SUPPRESSIVE THERAPY HAVE A DECREASED HUMORAL RESPONSE TO SARS-CoV2 VACCINATION?
Authors: R. Bourguiba, K. Dridi, M. Ayari, M. Boudokhane, I. Abdelaali, T. Jomni, S. Bellakhal, M. H. Douggui
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> SARS-Cov2 vaccination has been shown to be effective against severe forms of SARS-Cov2 infection. Several studies investigated the humoral and cellular response to SARS-Cov2 vaccines in patients followed for autoimmune and inflammatory diseases under immunosuppressive or immunomodulatory treatments. It has been shown that patients on immunosuppressive or immunomodulatory therapies have a poor humoral response to the vaccine[1] <h3>Objectives</h3> The aim of our study was to investigate the humoral response in patients under conventional immunosuppressive and biotherapies compared to healthy controls. <h3>Methods</h3> Patients followed for immuno-inflammatory diseases under immunosuppressive or immunomodulatory drugs who received at least one dose of anti- SARS-Cov2 vaccines were included. Quantitative Anti- SARS-Cov2 antibodies (IgM and IgG assay) VIDAS ® were assessed for all patients. Patients were then compared with healthy controls. <h3>Results</h3> We enrolled 93 blood samples (63 patients with autoimmune and inflammatory disease and 30 healthy controls), the median age was 52 years [Q1 43, Q3 56]. The immuno-inflammatory diseases were: Crohn's disease (n=28), Rheumatoid arthritis (n=9), Hemorrhagic rectocolitis (n=5), Behçet's disease (n=5), Systemic lupus erythematosus (n=4), Sjogren's syndrome (n=3), Sarcoidosis (n=2), Takayasu disease (n=1). All patients continued their treatment during and after vaccination. Nineteen patients were on biotherapies: Infliximab (n=12), Adalimumab (n=3), etanercept (n=2), Ustekinumab (n=1), tocilizimab (n=1). Forty-three patients were on conventional immunosuppressive: azathioprine (n=18), methotrexate (n=16), corticosteroids &gt; 10 mg/d (n=12). All patients had received at least one dose of vaccine: the median number of doses in both groups was 2[1-4] with no statistically significant difference between the 2 groups (p=0.2). The vaccines received in the group of patients were mRNA vaccine (n=35) and other type of vaccine (n=28). In the healthy control group, type of vaccine were mRNA (n=13) other type vaccine (n=17). The patient had a lower mean level of Ig G against SARS-Cov2 antibodies (24.64 IU +/- 16.65) comparing to healthy controls (33.05+/- 10) with statically significant difference (p= 0.014). No difference between the 2 groups was noted in Ig G levels according to the history of SARS-Cov2 infection. No difference was found between conventional immunosuppressive drugs and biotherapies regarding to the level of antibodies. <h3>Conclusion</h3> Our study highlights that patients with autoimmune disease and under immunosuppressive therapy displayed a decrease of humoral response comparing to healthy controls. This finding was reported in several studies, Geisen et al[2] reported that patients with chronic inflammatory condition and receiving TNF alfa blockers had a decreased protection and a low level Ig A against spike. Based on these data, patients with autoimmune and inflammatory diseases have decreased humoral immunity to SARS-Cov2 and should be encouraged to receive a booster dose of SARS-COv2 vaccine. <h3>References</h3> [1]Prendecki M, Clarke C, Edwards H, <i>et al.</i> Humoral and T-cell responses to SARS-CoV-2 vaccination in patients receiving immunosuppression. <i>Ann Rheum Dis</i> 2021;<b>80</b>:1322–9. doi:10.1136/annrheumdis-2021-220626 [2]Geisen UM, Sümbül M, Tran F, <i>et al.</i> Humoral protection to SARS-CoV2 declines faster in patients on TNF alpha blocking therapies. <i>RMD Open</i> 2021;<b>7</b>:e002008. doi:10.1136/rmdopen-2021-002008 <h3>Acknowledgements</h3> Mrs Hajer Mediouni. <h3>Disclosure of Interests</h3> None Declared.